The horrible events of the Boston Marathon are etched into our psyche that gives America a glimpse into what our military has faced every day for the past eleven years in Iraq and Afghanistan. One thing that worries me as a retired Army physician when I see injured soldiers –or a victim of terrorism—are the wounds I cannot see. If an IED blast was enough to cause the loss of a limb, it probably had enough energy to affect the brain causing a traumatic brain injury or TBI. These are the wounds we don’t see but may lead to personal challenges now or later. Such unseen brain injuries also are now a growing issue on the football and soccer fields around the country.
There are no magic pills or cures for TBI and it is unlikely there ever will be. YET, we must move forward.
Unfortunately, our medical system was formed around successes in fighting infectious diseases – one diagnosis: one drug. It hasn’t changed and adjusted to modern problems. The system does poorly dealing with complex situations such as TBI that present entirely different sets of challenges with a constellation of symptoms. Western medicine’s adaptation has been – one symptom : one drug – rather than addressing the underlying situation. The medical community needs to refocus on the whole patient, not relying on trying to find a single magic cure that will never exist. Instead, we paralyze ourselves waiting for that magical golden randomized clinical trial to prove that one drug will cure TBI. It isn’t going to happen, ever.
If it is essential to have omega-3 fatty acids to make a brain in utero, it reasons that they can be helpful to repair a brain after it has been injured. It is like a brick wall that’s been damaged. Wouldn’t you want to use bricks to repair the wall? Omega-3s, Decosahexanoic Acid (DHA) in particular, are literally the building blocks—the bricks–of the brain neuron cell wall. I’ve spent much of the past couple of years working to get that point across, first to the military, and since I retired, to the general public. I have to say, the progress in educating people, the medical community in particular, has been both slow and frustrating.
It turns out that Americans are generally very deficient in their omega-3 levels because of changes to the food chain that have occurred over the last half century. When Dr. Joe Hibbeln at the NIH and I did a rigorous evaluation of active duty military suicides, we came to two serious conclusions: in the blood samples we evaluated (800 documented suicides plus 800 well matched controls), omega-3 levels were profoundly low in the overwhelming majority of them; and even with the low levels, there was a 62% increased risk of suicide! We have no way of knowing how many of these were the result of a TBI because there are usually many factors involved in a suicide, but I’m sure some were.
There are good reasons to be concerned about low omega-3 levels in such brain injuries. They have a major influence on our immune systems. They keep inflammation under control when there is an injury and nowhere is that more important than in our brains. With the advent of corporate farming and subsidies to produce soybean and corn, our food supply has changed so much since the Second World War that our bodies are swimming in omega-6s, the highly inflammatory cousins of omega-3s.
We have learned there are no easy answers. When the medical system talks about “treatment” for TBI and concussion, this is a misnomer. What is called treatment is diagnostic testing and a “prescription” for rest – to allow time to heal the wounds. But there are other steps that can help. Several therapies including nutrition, omega-3 fatty acids, neuro-cognitive rehab, hyperbaric oxygen, and others, can have enormous impact, not to cure TBI, but to optimize the brain’s opportunity to heal itself and give a patient the best opportunity to regain as much function as possible. We must take these steps now.
Michael Lewis, MD, MPH, MBA, FACPM, is a retired Army Colonel and President of the Brain Health Education and Research Foundation (www.brainhealtheducation.org) which he founded in late 2011 to educate patients, parents, and providers focusing on optimizing health following a TBI. He is in private practice in North Bethesda, Maryland.